Fairy Tales
This type of child abuse occurs when a caregiver fails to obtain necessary medical care for a child's health needs.
What is neglect.
A child with type 1 diabetes has fruity breath odor and deep, rapid respirations. Is the child most likely experiencing hyperglycemia or hypoglycemia?
Hyperglycemia (diabetic ketoacidosis).
A child with autism spectrum disorder becomes distressed when the usual daily routine changes. What is the nurse's priority intervention?
Reestablish the child's usual routine.
An infant hospitalized with respiratory syncytial virus (RSV) bronchiolitis should be placed on this type of isolation to help prevent the spread of infection.
Contact Precautions
This laboratory finding is commonly seen in nephrotic syndrome due to excessive protein loss in the urine.
Low Serum Albumin (Hypoalbuminemia)
These three major organs or body systems are most affected by cystic fibrosis.
1. Lungs
2. Pancreas
3. Liver
Rationale: Cystic fibrosis is an inherited disorder that causes thick, sticky mucus to obstruct ducts and airways throughout the body. The lungs are affected by mucus accumulation, leading to chronic respiratory infections and progressive lung disease. The pancreas is affected by blocked pancreatic ducts, resulting in pancreatic enzyme deficiency, malabsorption, steatorrhea, and poor growth. The liver may develop biliary obstruction and scarring, leading to hepatobiliary complications such as biliary cirrhosis. These three organs are the primary systems involved and are the focus of assessment, treatment, and long-term management in children with cystic fibrosis.
During a routine assessment, the nurse observes that a 2-year-old child has muscle stiffness, poor coordination, and delayed motor development. These findings are most consistent with this neurologic disorder.
Cerebral Palsy.
Rationale: Cerebral palsy is a nonprogressive neurologic disorder caused by injury to the developing brain. It primarily affects movement, muscle tone, posture, and coordination. Common clinical manifestations include muscle stiffness (spasticity), poor coordination, delayed motor milestones, abnormal gait, and impaired balance. Early recognition allows prompt referral for physical, occupational, and speech therapies to maximize function and development.
An infant develops sudden episodes of severe abdominal pain, draws the legs up toward the abdomen, and has periods of calm between episodes. These findings are most consistent with this gastrointestinal disorder.
Intussusception
Rationale: Intussusception occurs when one segment of the intestine telescopes into another, causing intermittent bowel obstruction. Classic manifestations include sudden, severe, colicky abdominal pain with periods of relief, drawing the legs toward the abdomen, vomiting, and eventually currant jelly stools.
Children with juvenile idiopathic arthritis should perform range-of-motion exercises after this daily activity to reduce joint stiffness.
A warm shower or bath.
Rationale:
Warmth helps reduce joint stiffness and improve flexibility, making range-of-motion exercises more comfortable and effective.
Achieving growth and developmental milestones, promoting self-care, reducing anxiety, and encouraging social interaction are important goals when caring for this type of child.
Chronically ill
Rationale: Nursing care for the chronically ill child focuses on promoting normal growth and development despite long-term illness. Goals include maximizing independence through self-care, reducing anxiety related to illness and hospitalization, encouraging age-appropriate social interactions, and supporting the child and family in adapting to the chronic condition. These interventions help improve quality of life and foster normal physical, emotional, and social development.
Children with this disease cannot tolerate gluten. Damage to the small intestine causes malabsorption, resulting in bulky, pale, greasy stools (steatorrhea).
Celiac disease
Rationale: Celiac disease is an autoimmune disorder triggered by gluten, a protein found in wheat, barley, and rye. Gluten damages the villi of the small intestine, impairing nutrient absorption. As a result, children commonly develop malabsorption, bulky pale greasy stools (steatorrhea), abdominal distention, poor weight gain, and growth delays. Lifelong adherence to a gluten-free diet is the primary treatment.
Urticaria (hives), pruritus (itching), abdominal pain, and respiratory symptoms are common manifestations of this condition in children.
Food Allergies
A child recovering from chickenpox develops persistent vomiting, confusion, and lethargy after receiving aspirin. The nurse should suspect this condition.
Reye Syndrome
Rationale: Reye syndrome commonly begins with persistent vomiting followed by neurologic deterioration, including lethargy, confusion, seizures, and coma. A history of aspirin use during a recent viral illness is a key clue.
Persistent constipation caused by a partial or complete mechanical obstruction of the large intestine is characteristic of this congenital disorder.
Congenital Aganglionic Megacolon/Hirschsprung's Disease
Rationale: Hirschsprung disease is a congenital disorder caused by the absence of ganglion cells in a portion of the large intestine. Without these nerve cells, the affected bowel cannot relax, resulting in a functional mechanical obstruction. Clinical manifestations include delayed passage of meconium, chronic constipation, abdominal distention, vomiting, and poor growth. Treatment involves surgical removal of the affected segment of bowel.
During nutritional rehabilitation, a falling level of this electrolyte is an early indicator of refeeding syndrome.
Phosphorus
Rationale: During nutritional rehabilitation of a severely malnourished client, phosphorus shifts rapidly from the bloodstream into the cells as metabolism increases. This causes hypophosphatemia, one of the earliest laboratory indicators of refeeding syndrome. If not recognized and treated promptly, refeeding syndrome can lead to life-threatening complications such as cardiac dysrhythmias, respiratory failure, seizures, and death. Close monitoring of serum phosphorus is essential during the early stages of nutritional rehabilitation.
Children with this disorder experience progressive muscle weakness and loss of muscle mass that eventually results in impaired physical mobility.
What is muscular dystrophy
Rationale: Muscular dystrophy is a group of inherited disorders characterized by progressive degeneration of skeletal muscles. Children experience gradually worsening muscle weakness, loss of muscle mass, difficulty walking, frequent falls, and impaired mobility. As the disease progresses, many children require assistive devices such as wheelchairs and may develop respiratory and cardiac complications. Nursing care focuses on maximizing mobility, preventing contractures, promoting independence, and supporting the child and family throughout disease progression.
This diagnostic test measures airway function, lung volumes, and gas exchange to evaluate respiratory function in children with chronic lung diseases such as asthma and cystic fibrosis.
Pulmonary function tests (PFTs)
Rationale: Pulmonary function tests (PFTs) evaluate how well the lungs are working by measuring airflow, lung volumes, and gas exchange. They are commonly used to diagnose and monitor respiratory disorders such as asthma and cystic fibrosis, assess the severity of lung disease, and evaluate the effectiveness of treatment. Abnormal results may indicate airway obstruction, restricted lung expansion, or impaired gas exchange.
The purpose of the hip brace used to treat Legg-Calvé-Perthes disease is to maintain proper alignment of this structure during healing.
Femoral head
Rationale: The brace helps keep the femoral head positioned within the acetabulum while blood supply returns and healing occurs.
A child presents with mild edema, decreased urine output, hypertension, moderate proteinuria, bilateral flank pain, and headache. The nurse should suspect this condition.
What is Acute Glomerulonephritis or Post-streptococcal glomerulonephritis.
Rationale:
Rationale
Acute glomerulonephritis is characterized by inflammation of the glomeruli, resulting in decreased glomerular filtration. Reduced kidney function leads to fluid retention, causing edema, hypertension, oliguria, and proteinuria. Headache may occur because of hypertension, and flank pain can result from kidney inflammation. Recognizing this pattern of findings is essential for early diagnosis and management.
A 5-week-old infant has progressive vomiting after feedings, remains hungry immediately after vomiting, has poor weight gain, and a small olive-shaped mass is palpated in the upper abdomen. The nurse should suspect this condition.
Pyloric Stenosis
Rationale: Pyloric stenosis is caused by hypertrophy of the pyloric muscle, resulting in gastric outlet obstruction. As the obstruction worsens, infants develop progressive, forceful vomiting after feedings, remain hungry because little food reaches the intestines, and may experience dehydration and poor weight gain. A palpable olive-shaped mass in the right upper abdomen is a classic assessment finding. Early diagnosis and surgical correction (pyloromyotomy) are the definitive treatment.
This form of protein-energy malnutrition results from a severe protein deficiency despite adequate caloric intake.
Kwashiorkor
Rationale: Kwashiorkor is a form of severe malnutrition caused primarily by inadequate protein intake while calorie intake may be adequate. Children commonly present with edema, a distended abdomen, fatty liver, muscle wasting, skin lesions, and hair changes (alopecia or depigmentation). It differs from marasmus, which results from deficiencies in both calories and protein and is characterized by severe wasting without edema.
A child develops fever, localized bone pain, swelling, warmth over the affected area, and refuses to bear weight on the affected leg. The nurse should suspect this condition.
Osteomyelitis
Rationale: Osteomyelitis is a bacterial infection of the bone, most commonly caused by Staphylococcus aureus. Children typically present with localized bone pain, swelling, warmth, fever, and refusal to bear weight or use the affected extremity. Early diagnosis and treatment with intravenous antibiotics are essential to prevent permanent bone damage.
This class of medications is considered the first-line drug therapy for children with juvenile idiopathic arthritis (JIA).
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Rationale: NSAIDs are the initial treatment for most children with juvenile idiopathic arthritis because they reduce inflammation, relieve pain, and improve joint mobility. Common NSAIDs used in children include naproxen, ibuprofen, and indomethacin. If symptoms are not adequately controlled, additional medications such as disease-modifying antirheumatic drugs (DMARDs) or biologic agents may be prescribed.
Covering the stronger eye to strengthen vision in the weaker eye is a common treatment for this condition.
Amblyopia
Rationale: Amblyopia develops when one eye has reduced vision because the brain favors the stronger eye. Patching the stronger eye encourages the weaker eye to develop normal vision.
This disease, historically seen in sailors, causes bleeding gums, joint pain, poor wound healing, and petechiae due to a deficiency of vitamin C.
Scurvy
Rationale: Scurvy is caused by a deficiency of vitamin C (ascorbic acid), which is essential for collagen synthesis and wound healing. Children with scurvy may develop swollen or bleeding gums, petechiae, bruising, joint pain, bone pain, poor wound healing, and anemia. Although rare today, scurvy can occur in children with severely restricted diets or nutritional deficiencies. Early recognition and vitamin C replacement reverse the symptoms.
Croup causes edema of the larynx, trachea, and bronchi. According to your textbook, what are the three major clinical signs of increasing respiratory distress?
Tachypnea (increased respiratory rate), retractions, and nasal flaring.
Rationale: As airway edema worsens in croup, the child must work harder to breathe. The three classic signs of increasing respiratory distress are:
These findings indicate worsening upper airway obstruction and require prompt assessment and intervention to prevent respiratory failure.
A child presents with fever, nuchal rigidity, photophobia, severe headache, and a positive Kernig's and Brudzinski's sign. The nurse should suspect this condition.
Meningitis
Rationale: Meningitis is an inflammation of the meninges surrounding the brain and spinal cord, most commonly caused by a bacterial or viral infection. Classic manifestations include fever, severe headache, nuchal rigidity, photophobia, and positive Kernig's and Brudzinski's signs.
A positive Kernig's sign occurs when the child experiences pain or resistance while the hip is flexed and the knee is extended, indicating meningeal irritation.
A positive Brudzinski's sign occurs when passive flexion of the neck causes involuntary flexion of the hips and knees, also indicating meningeal irritation.
Prompt recognition and treatment are essential to prevent serious complications such as seizures, increased intracranial pressure, neurologic damage, and death.
Children with Duchenne muscular dystrophy often use this maneuver to rise from the floor because of progressive weakness of the hip and thigh muscles.
Gowers' sign
Rationale: Gowers' sign is a classic finding in children with Duchenne muscular dystrophy. Because of progressive weakness of the proximal muscles of the hips and thighs, the child is unable to stand from the floor without using the hands to "walk" up the legs for support. This maneuver is an early indicator of muscle weakness and is commonly seen in children with Duchenne muscular dystrophy. The disease is characterized by progressive muscle degeneration, leading to loss of ambulation, respiratory muscle weakness, and cardiomyopathy over time.
A child weighs 34 lb 8 oz. The provider prescribes 15 mg/kg of a medication. The medication is available as 125 mg/5 mL.
Round the child's weight to the nearest hundredth place and round the medication dose to the nearest tenth place.
How many mL should the nurse administer?
9.4 mL
Rationale:
The nurse should administer 9.4 mL.
Due to the immunosuppressive effects of medications used to treat nephrotic syndrome, this becomes a critical priority of nursing care.
Preventing Infection
Rationale: Children with nephrotic syndrome are often treated with corticosteroids and other immunosuppressive medications, which decrease the body's ability to fight infection. In addition, the loss of immunoglobulins in the urine further increases susceptibility to infection. Nursing care focuses on preventing infection by monitoring for signs of illness, practicing good hand hygiene, avoiding exposure to individuals with contagious infections, and educating the family to promptly report fever or other signs of infection.
Children with cystic fibrosis should receive pancreatic enzymes when.
Before every meal and snack?
Rationale: Pancreatic enzymes should be administered immediately before all meals and snacks to aid digestion and absorption of fats, proteins, and carbohydrates. Giving the enzymes after eating decreases their effectiveness and can contribute to malnutrition and poor growth.
Confusion, drowsiness, headache, and fatigue occur during this phase of a seizure.
Postictal phase?
Rationale: The postictal phase follows the seizure and is characterized by confusion, drowsiness, fatigue, headache, and temporary neurologic deficits. The child may sleep for several hours after the seizure as the brain recovers from abnormal electrical activity.
Quick Memory Aid
Prodromal Phase
Rationale: The prodromal phase occurs hours to days before a seizure and may include subtle behavioral or emotional changes such as irritability, mood changes, anxiety, difficulty concentrating, or sleep disturbances. Not every child experiences a prodrome.
Aura Phase
Rationale: The aura is the earliest part of the seizure and is considered a focal seizure. The child may experience unusual sensations such as a strange smell or taste, visual disturbances, dizziness, numbness, or a feeling of déjà vu. An aura serves as a warning that a seizure is about to occur.
Ictal Phase
Rationale: The ictal phase is the active seizure. Manifestations depend on the seizure type but may include loss of consciousness, tonic-clonic movements, staring, automatisms, muscle rigidity, or rhythmic jerking. The priority during this phase is maintaining the child's safety and airway.
A child has a generalized tonic-clonic seizure, briefly stops jerking for a few seconds, and then begins seizing again without regaining consciousness between episodes. This condition is considered a neurologic emergency.
Status epilepticus
Rationale: Status epilepticus is a neurologic emergency defined as a seizure lasting 5 minutes or longer or recurrent seizures without regaining consciousness between episodes. Prolonged seizure activity can lead to hypoxia, metabolic acidosis, cerebral injury, respiratory compromise, and death. Immediate intervention is required to stop the seizure and maintain airway, breathing, and circulation.
Early identification and treatment of profound hearing loss are essential to prevent delays in this area of development.
Speech and language development
Rationale: Hearing is critical for normal speech and language acquisition. Without early intervention, children with profound hearing loss are at risk for significant delays in communication, learning, and social development.
To obtain the most accurate specimen for diagnosing a pinworm infection, this test should be performed before the child bathes or uses the bathroom in the morning.
Scotch tape test
Rationale: Female pinworms migrate to the perianal area at night to lay eggs. The Scotch tape test is performed first thing in the morning before bathing or toileting because these activities can remove the eggs and produce a false-negative result.
Softening of the occipital skull bones (craniotabes), delayed dentition, bowed legs, and thoracic deformities are classic manifestations of this childhood disorder.
Rickets
Rationale: Rickets results from vitamin D deficiency, leading to impaired calcium and phosphorus absorption and poor bone mineralization. Classic findings include craniotabes, delayed tooth eruption, bowed legs, thoracic deformities, and growth delays. Treatment includes vitamin D supplementation and adequate calcium intake.